Neonates anesthetic agents

Propofol Propofol has been relatively free of acute side effects other than those associated with its mechanism of action. Continuous infusions lasting greater than 10 days in ICUs have demonstrated no significant apparent toxicities. Propofol is not recommended for obstetrics, including cesarean section deliveries. It crosses the placenta, and as with other general anesthetic agents, may be associated with neonatal depression. Propofol is not recommended for use in nursing mothers because it is excreted in human milk, and the effects of oral absorption of small amounts of propofol in newborn and infants are not known. 

The authors postulated that either local anesthetic could have been responsible, but that the oxidant effects of the two agents may have been additive. They highlighted the need for awareness of seemingly minor uses of medications in neonates. 

Maternal hypotension and excessive placental transfer of local anesthetics and other drugs, for example narcotics or sedatives, given to the mother before or during delivery are the main causes of neonatal death related to the use of these agents in obstetrics. However, deaths are very infrequent (155). 

When an opioid is used as the sole agent by the epidural or intrathecal route, the results are disappointing, because of unwanted adverse effects, such as pruritus, nausea, vomiting, respiratory depression, and effects on the neonate, caused by significant systemic absorption (SEDA-17, 85). Hypotension and changes in fetal heart rate are not uncommon (SEDA-21, 91). Combinations of opioids (alfentanil, fentanyl, morphine, sufentanil) with local anesthetics (for example bupivacaine) have therefore been suggested to yield better results (SEDA-18, 83). 

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